Emily Collis and Katherine Sleeman say that decision making can be ethically sound only with a fully informed patient, but Leslie Blackhall (doi:10.1136/bmj.f2560) thinks the concept of “terminal illness” is not clearly defined and that prognoses can never be certain

Patients have the right to make informed decisions about their healthcare. Informed consent, and the process of balancing risks and benefits of treatment, is a fundamental ethical principle.1 This principle is no less relevant for a patient with terminal illness, for whom an awareness of the incurable and life limiting nature of their underlying condition is essential to decision making.

Knowledge gives power

Decision making in terminal illness extends from the medical treatments and supportive care to decisions around advance planning of care, finances, guardianship, power of attorney, and voicing preferences for place of death. Worryingly, such decisions are not always fully informed. A recent study showed that 69% of 710 US patients with incurable lung cancer (and 81% of 483 patients with colorectal cancer) who received palliative chemotherapy were not aware that this was unlikely to cure the cancer.2 On the other hand, being …

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